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Adult Clinical Medicine > Radiology - Exam 1 > Flashcards

Radiology - Exam 1 Flashcards

(52 cards)

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1
Q

contrast material used with CT and contraindications for use

A

iodine
allergy to iodine

contraindications for abdominal CT:

  • retroperitoneal bleed
  • diabetes (not on Metformin)
  • acute renal failure (serum creatinine >1.5 concern; GFR < 30 concern)
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2
Q

contrast material used with MRI and contraindications for use

A

gadolinium

severe renal failure (GFR<30)

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3
Q

resource: indication of when to do head CT (HCT) in trauma cases

A

PCARN

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4
Q

preferred imaging - appendicitis in adults

A

abdominal CT

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5
Q

preferred imaging - appendicits in kids / pregnant women

A

abdominal U/S - first

CT with contrast - if not seen on U/S

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6
Q

preferred imaging - bony areas of head (posterior fossa and stella turcica)

A

use plain x-ray or MRI

- CT not good due to highly dense bony areas

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7
Q

things to consider when ordering imaging

A

cost
radiation exposure (risks)
burden (time)

Must be indication driven imagining - particular reason for ordering study

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8
Q

imaging for trauma in child

A

stable: trauma series (plain film of chest, pelvis, c-spine)

unstable / suspicion of head trauma: CT

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9
Q

imaging for limp in child

A

plain film (1st): fracture, foreign body

U/S: hip effusion, infection, synovitis

MRI: myositis, marrow, abscess, osteomylitis

Bone scan: osteomyelitis, bone METS

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10
Q

standard imaging - chest radiograph

A

upright PA view with corresponding lateral view

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11
Q

standa imaging - abdomen

A

3-way: upright and supine abdomen, upright chest

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12
Q

when to do a CXR for acute respiratory illness in a healthy (immunocompetent) person

A

based on ACR appropriateness criteria

older than 40
dementia
positive PE
hemoptysis (cough up blood)

associated abnormalities (leukocytosis, hypoxemia)

other risk factors: CAD, CHF, drug-induced acute resp. failure

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13
Q

silhouette sign - what is it used for

A

helps to identify location of of pneumonias or lesions on CXR

loss of normal radiographic silhouette due to two substances of same density being in direct contact

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14
Q

air bronchogram sign

A

seen on CXR with fluid in lungs

typically, air in bronchi and lungs makes it difficult to see bronchial tree; however, they stand out (dark) when fluid is in lungs (pneumonia)

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15
Q

effusion (e.g. pleural effusion)

A

excess fluid in lungs

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16
Q

most sensitive view for pleural effusion

A

decubitus - can demonstrate effusions of 15-20 ml

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17
Q

pneumothorax - abnormalities on CXR

A 
visceral pleural line (necessary!)
convex curve of visceral pleural line
absent lung markings distal to visceral pleural line
cardiac/hemidiaphragm shift
deep sulcus sign
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18
Q

deep sulcus sign

A

excess air in costophrenic angle indicative of pneumothorax

- seen on supine view

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19
Q

pleural effusion - abnormalities on CXR

A

fluid in pleural space

  • shifts with position (unlike pneumonia)
  • fist seen below lungs (subpulmonic location)
  • decubitus: most sensitive view for pleural effusion
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20
Q

aortic aneurysm - abnormalities on CXR

A

widened mediastinum

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21
Q

pneumoperitoneum - abnormalities on CXR

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A

air in peritoneum (lining of abdominal cavity)
- crescent lucency on undersurface of rt hemidiaphragm

causes: ruptured bowel, trauma, post-surgery

22
Q

COPD - abnormalities on CXR

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A

elongation and narrowing of heart
flattening of diaphragm
inc. rib count (>9)

23
Q

cardiomegaly - abnormalities on CXR

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A

cardiac:thoracic ratio > 50%

Note: heart should take up less than 50% thorax

24
Q

aspiration pneumonia - abnormalities on CXR

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A

right and left heart borders obscured; infiltrate to bases

25
Rigler's sign
both walls of bowel visible (typically not) - indicates large amount of free air in supine abdominal x-ray
26
hematochezia
passage of fresh blood through anus with or w/o stool | - indication for barium enema
27
standard imaging - gallbladder disease (biliary disease, acute cholecystitis)
abdominal U/S
28
imaging of GI (non-invasive)
esophagram barium upper GI study ("barium swallow" small bowel follow through
29
imaging of GI (invasive)
``` EGD: esophagogastroduodenoscopy ERCP capsule endoscopy sigmoidoscopy / colonoscopy EUS: endoscopic ultrasound ```
30
abdominal MRI - when to use (rare)
``` adrenal pathology biliary pathology (MRCP - similar to ERCP) female pelvis (transplants) ```
31
gallbladder disease: imaging and labs
imaging: abdominal U/S labs: - gallbladder (bile) - liver: ALT/AST - pancreas: lipase/amylase
32
plain films of skull - indications
penetration foreign body presence of depressed skull fragments (likely CT) bony areas: posterior fosse / stella turcica waters' view: sinuses
33
Waters' view
45 degree angle (plain film) into anterior skull / face - good image of sinuses - compare bilaterally
34
CT of head/brain (non-contrast) - indications
``` trauma (at all unstable) depressed skull or facial fracture acute intracranial hemorrhage hydrocephalus (water in brain) intracranial infection (meningitis, sinusitis) acute venous/dural sinus thrombosis ```
35
MRI of head/brain - indications
``` neoplasma demyelinating diseases (MS) vascular malformations (AVM or aneurysm) new onset seizure examine bony areas (posterior fosse / stella turcica) infection or inflammation trauma (diffuse axonal injury) ```
36
MRI of spine - indications
``` disc disease (degenerative, infection) spondylolydid: bony defect or fracture congential abnormalities neoplasm: cord, meningeal infection: epidural absces inflammation: MS ```
37
CT of spine - indications
spinal column damage trauma / emergencies: internal injuries or bleeding - FAST! if MRI contraindicated (metal in body) or unavailable
38
acute stroke - approach to imaging
``` head CT (no contrast) - 1st - determine if hemorrhagic v. ischemic stroke ``` MRI (follow-up): more sensitive
39
headache - approach to imaging
``` MRI: Thunderclap H/A (CT if unstable) HA that worsens with exertion, associated w/ dec. alertness, positionally related, awakens one from sleep, changes pattern over time New HA in HIV pos. pt HA w/ papilledema HA w/ focal neurological defect HA w/ mental status change ``` CT: Trauma, unstable (FAST!) Suspected hematoma MRI contraindicated or unavailable
40
vertigo - approach to imaging
typically no imaging brain CT: signs of conductive hearing loss brain MRI: signs of sensorimotor hearing loss
41
seizure - approach to imaging
MRI: - new onset - anyone (including alcoholic) - epilepsy w/ poor therapeutic response - focal nerological defect - abnormal EEG CT (non contrast): - trauma No imagining: - otherwise healthy children - febrile seizure - chemical withdraw
42
dementia - approach to imaging
MRI: useful for diagnosing treatable conditions (vascular disease, etc.)
43
radiculopathy - approach to imaging
red flag for spinal imaging (likely MRI or CT)
44
when to use CT or MRI contrast
head: no chest: no (except nodules, interstitial disease, pulmonary emboli) abdomen/pelvis: yes (except kidney stones)
45
constipation - approach to imaging
plain x-ray (visualize masses - more dense) - combine with hx and PE note: bowel looks like mass/density with air bubbles
46
FAST exam - definition and purpose
Focused Assessment with Sonography in Trauma - purpose of bedside ultrasound in trauma is to rapidly identify free fluid (usually blood) in the peritoneal, pericardial, or pleural spaces
47
abdominal CT - indications
test of choice for abdominal pain unless gallbladder is suspected (use U/S)
48
pituitary gland concerns - clinical/labs
``` thyroid (TSH) gonads (LH, FSH) growth hormone adrenal glands (ACTH / cortisol) breasts (prolactin) ```
49
angiography
Inject contrast into artery to highlight vessels with x-ray is taken Indications: - Definition of atherosclerotic occlusive disease. - Evaluation of aneurysms - Trauma to cervicocerebral vessels - Evaluation of tumor vascularity - Evaluation of vasculitis
50
acute back pain - imaging
pain > 6 weeks (unless "red flags" red flags: - inc. risk of cancer - risk of spinal infection - sx of cauda equina syndrome - trauma hx (esp. w/ osteoporosis, or >50) - radiculopathy (severe neuro deficits)
51
spondylolosthesis
slippage of one vertebral body on the one below - often L5-S1 area (curvature of low back)
52
spondylolysis
fracture of pars interacticularis | "scotty dog sign"

Adult Clinical Medicine (5 decks)

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